Establishing Entrustable Professional Activities in Pediatric Cardiac Critical Care*

Abstract

OBJECTIVES: Define a set of entrustable professional activities for pediatric cardiac critical care that are recognized as the core activities of the subspecialty by a diverse group of pediatric cardiac critical care physicians and that can be broadly and consistently applied irrespective of training pathway.DESIGN: Mixed methods study with sequential integration of qualitative and quantitative data. SETTING:Structured telephone interviews of pediatric cardiac critical care medical directors at Pediatric Cardiac Critical Care Consortium centers followed by an electronic survey of pediatric cardiac critical care physician members of the Pediatric Cardiac Intensive Care Society from across the United States and internationally. SUBJECTS:Pediatric cardiac intensive care physicians. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS:Twenty-four of 26 eligible Pediatric Cardiac Critical Care Consortium medical directors participated in the interviews. Based on qualitative analyses of interview data, we identified an initial set of nine entrustable professional activities. Fifty-eight of 185 eligible physicians completed a subsequent survey asking them to rate their agreement with the entrustable professional activities. It showed consensus (> 80% agreement) with the entire initial set of entrustable professional activities, with greater than 96% agreement in most cases. The feedback from free-text survey responses was incorporated to generate a final set of entrustable professional activities. CONCLUSIONS:We generated a set of nine entrustable professional activities, which we believe can be broadly applied to any physician training in pediatric cardiac critical care, irrespective of individual training pathway. Next steps include incorporation of these entrustable professional activities into curriculum design and trainee assessment tools.

High variability in cardiac education and experiences during United States paediatric critical care fellowships

“…3,5,14 A recent survey of paediatric critical care medicine directors indicated that approximately 33% of cardiac ICU staff physicians are double-boarded in paediatric critical care medicine and cardiology, 12.5% underwent paediatric critical care medicine fellowship and a 1-year cardiac ICU fellowship, 30% underwent cardiology fellowship in addition to a 1-year cardiac ICU fellowship, and 21% underwent paediatric critical care medicine fellowship with no additional training (including those who were practising long before the addition of the 1-year cardiac ICU and dual fellowship training pathways became readily available). 16 The 1-year paediatric cardiac critical care fellowship even has standardised training guidelines now; however, dual boarding in cardiology and paediatric critical care medicine remains the gold standard. 1 While paediatric residents commonly staff mixed units, paediatric critical care medicine fellows are predominant learners in cardiac ICUs, perhaps allowing for more fellow practice autonomy.…”

Editor’s Choice Articles for January

“…The authors also provide readers with an Appendix of learning objectives for subspecialty education and training in PCCCM that is well worth studying closely. Second, a mixed-methods report using interviews of medical directors involved with the pediatric cardiac critical care consortium (PC 4 ) as well as other physicians in the field (5). Here, the objective was to identify and define the core training entrustable professional activities that could be applied to practice in PCCCM.…”

Entrustable Professional Activities and Their Relevance to Pediatric Cardiology Training

“…While the framework is thorough, it is time- and resource-intensive to track EPAs for every fellow during their training [ 15 ]. There has also been the creation of EPAs pertaining to pediatric cardiology subspecialties, such as cardiac critical care [ 38 ]. The inherent flexibility of the EPA framework allows program directors to determine how they wish to utilize EPAs in their fellowship program and therefore limits assessing their efficacy and utility [ 4 , 14 ].…”